Paroxysmal atrial tachycardia (PAT) is a condition in which the upper chambers of the heart, the atria, begin to beat irregularly, sometimes producing heartbeats as fast as 200-220 beats per minute (bpm). The condition is called paroxysmal, since it occurs suddenly and without warning. In people with no abnormal heart conditions, this is usually considered not a dangerous arrhythmia, but in people who have had corrective heart surgeries especially the Fontan operation, it can be life threatening.

There are a few potential causes of PAT. Some people have additional heart tissue that acts as an extra conductor, causing the heart to occasionally produce rapid beats. This is called Wolff Parkinson White Syndrome (WPW). In other cases, a small abnormality exists in the atrial node, creating occasional racing of the heart or palpitations. Other times, the condition can be induced by people who are alcoholics, or by those who consume excess caffeine. Women who are menstruating may also experience palpitations.

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It’s difficult to diagnose paroxysmal atrial tachycardia since it doesn’t happen all the time. Unless you are doing an EKG on a person while it is happening, you won’t necessarily see anything abnormal in the heart rhythm. If a person is experiencing palpitations, what usually occurs is that they wear what is called a cardiac event monitor. If they begin experiencing rapid heartbeat, they press a button, which records the “event” via several probes attached to the chest. An event monitor can be worn for several weeks in order to capture PAT episodes. Alternately, if the symptoms are occurring frequently, a 24-hour Holter monitor may be used to catch fast and extra beats.

The symptoms of paroxysmal atrial tachycardia can last for a few minutes to several hours. When rapid heartbeat remains for more than a minute or two, a person can feel out of breath, have chest pain, dizziness, have a panic attack, or faint. It is a scary thing to endure several hours of this condition, even when it does not cause pain or fainting. Dizziness and fainting can be caused by the atrial chambers not being able to fill fully, thus leading to inadequate blood supply to the body and lungs. Though this is rarely life threatening, with children who’ve undergone surgeries like the Fontan, it can result in sudden death.

If paroxysmal atrial tachycardia occurs rarely, the condition may not be treated. Doctors may instead suggest avoiding caffeinated beverages and keeping a log of occurrences. When it occurs often, doctors look for cause, and ways to treat it. Where WPW exists, doctors called electrophysiologists will perform a cardiac ablation, a non-surgical procedure done via catheterization that essentially destroys the extra tissue sending false signals to the heart to beat too rapidly. In many cases, people might require medication when PAT is occurring frequently and WPW is not present.

When paroxysmal atrial tachycardia doesn’t respond to medications, cardiac ablation may be tried, or patients can have a defibrillator implanted (similar to a pacemaker), which helps to control and regulate heart rhythms. Patients who have had the Fontan are quite likely to have this method of treatment, since for them, the heart beating at a rapid pace can be life threatening.

Discuss this Article

JohnWrightPost 36

Taking a daily half hour, 1.2 kilometer swim using a front-mounted snorkel cured my PAT that was occurring every 48 hours for up to three hours. Anyone else's PAT cured with daily exercise like swimming or stationary biking?

anon325374Post 34

I've had PAT since my late 20's and I did the cardiologist test thing too but to no avail. The PAT didn't show up. I've had PAT episodes off and on for years and the first thing I do within five minutes is lie flat on my back and prop my feet above my heart and relax. If it doesn't stop within a few minutes, I go to the ER and they give me some medicine in my IV and monitor me for a few hours.

Sudden movement, stress, or nothing triggers an episode. I live life normally, eat mainly fruits and veggies, no red meat or dairy and I rarely have an episode.

anon325080Post 33

I had my first frightening attack of SVT's when I was 19, not long after my first child was born via c section. I am now 57.

It is the most horrid and frightening experience. In those days the doctors thought it was stress! I mostly was too frightened to go out when it struck and lay in bed thinking I was going to die (my heartbeat went up to 235 bpm) until it reverted sometimes hours or even days later!. This went on for years, thus I couldn't travel and it affected my life terribly.

One hospital wanted to put in a pacemaker. Over those years I had all sorts of meds for it. I took Digoxin, beta blockers

, verapamil (which brought on a frightening rush about 20 minute after swallowing). I always felt it was triggered by hormonal fluctuations, stress, not enough sleep, dieting. I was one of the first patients in my hospital to be given Adenosine in an IV bolus (still was experimental), which mostly, depending on the experience of the doctor at the time, helped my heart revert to sinus rhythm on the first dosage. I had a sudden rush that felt like my arms and legs were going to explode off my body and my chest and head felt intense pressure for a few seconds -- then pure relief! I was home again in half hour until the next time, which was usually within the week.

After all the years of suffering with it, my cardiologist talked me into having catheter abalation. I refused unless he put me totally to sleep while doing it. I woke up and since then (2006) I haven't had to go to the emergency room for reversion. I still get Junctional Ectopic beats but no SVT's. They got the extra pathway and burned it off. It was within a hair's breath of my sinus node! I now can study, go away on trips out and travel without the fear of taking a turn and having to rush to hospital. I live in Australia.

Wow, I never knew there was a connection to Rheumatic Fever and PAT. When I was little, I got Scarlett Fever and had strep throat all the time. My PAT showed up around the age of 6. It often starts when I am reaching down and then stand up. Sometimes it lasts for a few seconds, and other times it lasts for a few hours.

As a child, my cardiologist told me to stay away from caffeine, chocolate, stress, make sure to get a good night's sleep, and sure enough, those are *all* triggers for me. Too bad I love chocolate! But now I have no tolerance for caffeine and just the smallest amount can keep me up all

night.

My episodes do not happen frequently anymore, just once in a while, almost always if I am stressed out and sleep-deprived. Therefore, I make sure to reduce stress in my life and stay well-rested. I am not on any meds. I know someone who had the catheter ablation, and they are *very* happy with the results. I would suggest any of you who are having a hard time with PAT to look into that procedure.

I have had PAT since I was 14 years. old. Now I'm 65 and it is still with me. I have found that when it hits and holding my breath doesn't get it back to a regular cycle I have to exhale and not inhale until I can't stand it any longer. This usually causes your hands to shake. Then inhale deeply and hold, which usually works. I was fortunate to have an ultrasound done when it was at 250 bpm. It was taped and I was such a star with all of the nurses.

anon307401Post 30

Guess you can say I am one of the lucky ones! I had my first PAT attack when I was about 13 and was a sports nut! I played football basketball and ran track. On my first occurrence, I asked my mom to feel my chest and the only thing she said was "You're just having growing pains". In track, I ran the mile and usually the third lap it would start, but I was able to run a mile with a time of 4:38.

It wasn't until I was 21 and in the Navy when they actually documented it. At the time they really didn't know what to do, so my doctor asked me to hold my breath and

submerse my head in ice and water. Which is a good way to do it, but not with your head; it should be your wrists. At the time, I was having 6 to 10 episodes a day and this continued for six months after I got out of the service. A miracle per se after all those months! I went through a divorce! What was creating my problems were simple: it was stress!

I had episodes for the next 25 years but slowly they have disappeared. At 57, I had one in the last year and it lasted less than a minute. I've had tests and I have minimum blockage (20 percent), which they stated was most likely caused by the PAT being so bad and the drugs I used to suppress didn't help at all -- digoxin! Good luck to everyone who reads it and don't panic. You're going to be all right. Trust me; I've been there and done that!

I started getting Paroxysmal atrial tachycardia "episodes" when I was 17-18 years old.

It was the usual fare: dizzy, lightheadedness, feeling like I was going to pass out and die. I've gotten pretty good at concealing it from everybody. I work as a professional skier and cyclist and have always wondered how it would affect me long term.

Now, I'm 44 years old and get episodes about two times a month. They seem to be getting worse, and more intense. I'll report back later.

anon295111Post 28

I have also had these kinds of fast heartbeats occasionally for more than 20 years. I had all the tests like a treadmill test, then an Eco-test. All the tests were normal. Recently I was monitored for 24 hours, but like all the ECG tests, it was also normal. I was given medicine like librium-10, calm tablets and Anxit several times.

Usually, but not always, it happens when I have too much gas and there is indigestion. I feel it myself and as some physicians also said it might be linked to that. Last year, one cardiologist gave me a medicine and injection which I did not not take/use. The doctor said that it's an additional blood entry opening

usually in every human being, and blood rushes through both arteries, in some cases, thereby causing the fast heartbeat.

I am male and am 61 now. When it started I was at that time very stressed. For more than 20 years it was for a very short time (a few seconds) and would stop immediately, as soon as I lay on my back. But with time, the duration increased and lying down did not immediately help. The time period has now shortened again, but the periods of fast heartbeat come many times in a year. But when it started,it was only once a year or so.

The doctors have told me I need to stop the breath upwards and pull also it downwards and take deep breaths sometimes, which helps sometimes to stop the fast beats. My doctors have said that it's not dangerous and advised exercise by walking, controlling my blood pressure, cholesterol, etc. What do

I do next? No doctor seems to be sure. I probably need advice from very experienced doctors.

I'm 23 and since a year ago, I've been getting the fast heartbeat and it's somewhat panicking. It's hard to focus on anything during those moments. I think it's stress and caffeine related for me.

During such moments I feel the urge to hold my breath, but if I hold my breath and push on my lungs for longer than two to three seconds I almost faint, a huge rush of warmth goes and it takes about 20 seconds to a minute to regain my senses again.

anon249190Post 26

I have had PAT since I was in my 30's. I am now 59. I had an old time doctor who did tests and got me into see a well-known cardiologist, and an echocardiogram was done. The result was PAT. He put me on very mild sedatives, and said to avoid soda, coffee and chocolate, and a that it wasn't life- threatening.

The worst time was around my menstruation. I was told many techniques to try to ward off the palpitations, like bending at the waist, massaging the neck artery and coughing deep, but the best and only treatment for me was a mild sedative medication.

As I get older and have had different doctors, from time to time, they

all want to drop the meds, saying they are addictive. Well, I am well aware of this, but it is the only relief I get. I agree that, at one time I was prescribed 1mg of Ativan three times a day, which was way too much. I am now down to half a milligram a day, but from time to time, I get a hard-to-control episode of palpitations, in which a second dose is needed, and I have to get agitated because doctors act like I'm an addict. But this is what works for me and makes me be able to function normally, because these attacks can and have sent me to the ER often.

If meds like this work for you, stand your ground until you find a doctor who understands. Ativan is a tranquilizer, and comes in a generic form, Lorazepam, and has never made me feel drugged, just calm and normal, with no fear, no panic and no more palpitations.

In these days of drug abuse, it is harder for us who need these meds when all other types of treatment have failed. Keep vigilant, and someone will listen to you. God bless.

I have had these episodes about once a year since I was six or seven. They have gotten worse with each pregnancy but are better after delivery.

I also hold my breath for a few seconds and find that many times, it returns to normal quickly. I also find (like a few of the posts) that it occurs when I stand up from a bent over position quickly.

anon242893Post 24

I am 24 years old. My PAT started when I was about 18 years of age. I become dizzy, light headed, faint, throw up without warning and become exhausted very quickly, even after waking up from a full night's rest. My attacks last from hours to days!

I am currently living with chronic fatigue and constant sore chest as well as bone pain in my arms. I just spent two days in the ER and I am currently on Anatole. Hopefully things will become better for me and everyone who suffers from this scary disorder. Much love and prayer! -W

anon206340Post 23

I had PAT as a side effect of rheumatic fever at age 8. I had heart cath and ablation twice because it didn't work the first time. I am so glad I had this done, I hated all the meds and nothing else seemed to work. Saint Vincents in Indianapolis is the best!

anon165376Post 22

I began to have Pat at age 17 also. I was doing nothing at the time just sitting in an ice rink watching a hockey game then all the sudden my heart began to race so quickly i could not catch my breath. It was beating so quickly that you could see it on the outside of my clothes.

I was taken to emergency and put on a monitor my heart rate was 240 BPM. I thought i was dying. I was given Valium and Verapamil they kept my in the hospital for a week monitoring me. Send me home on the wrong Meds. this kept happening. So eventually, i was placed on Inderal (Beta Blocker) which i have now

been on for 30 years also i was told i will be on this medication for life. I wish i could tell you i am cured but it seems like everyone else who also posted here there are just controlling my symptoms I have never heard of a cure either. If anyone has, could it please be posted.

I've had PAT since I was about 12. I've always hung upside down and that usually will jar it into stopping. I'm 31 now and still do the upside down thing on my piece of equipment that hangs ya by your ankles. I don't think I'll be doing that at 80 though. Who knows?

anon144682Post 20

I've had PAT since my teens, but not diagnosed until about 1992. It scared me!

I was told that here in Seattle, WA there was a cardiologist who invented the method of using the radio wave to zap the wrong electrical impulse that makes your heart beat 220+. Problem being if they zapped the wrong one, you'd have to live with a pacemaker. I was only 40, so I opted out!

I've had the Adenosine, which didn't work, they were getting ready to use the paddles, then gave me the stuff for the third time, and it worked. It was a very scary ER trip.

I lie flat on my stomach and chest, on a solid surface floor or hard

mattress, take a deep breath and hold it, which usually works after a time or two. Once it didn't. The longer the incident goes on, the harder it is to stop it, and get my heartbeat back to normal.

I'm on RX Atenolol for since '92, which has made most of my unbelievably thick hair, unbelievably thin. Great.

I was diagnosed with a mild form of P.A.T. when I was about 14 or 15 years old and I am now 30. I had walked a 5K and at the end decided to run. I felt like I was walking on air I was so dizzy at the end and asked my friend to get their mom. A nurse was there and took my pulse which was over 200 bpm. They gave me food, water, and were about to send me to the ER when it stopped and my rhythm returned to normal.

I went to a cardiologist soon after and they were not able to catch it or induce it through exercise on a treadmill. That, a checkup

, and my description is how he could tell what I had. He told me to hold my breath for 30 seconds or as long as I could and force a cough whenever it happened again. I have done this when I have occasional but rare instances of PAT and it always helps after one to three tries.

The strange thing is that it happens rarely and not always with real exercise. If I take a step out of sync with my breathing it might trigger it or if I get up too quickly. It's a strange annoying thing and it scares me if I'm alone but it always goes away. The cardiologist said that people with the worst cases of it faint and sometimes throw up. Get checked out if you have any issues.

Went skiing in Keystone, Colorado. Three days of hard skiing and not drinking enough water. Drinking lots of coffee in the morning too. Everyone told me to stress breathe.

I am a nurse and knew this was trouble when my heart rate was at 150. Off to ski patrol and down the mountain in the gondola. To the ER, bagels did not work. I was given Adenosine and I converted. It was a scary experience to be on the other side. I have administered Adenosine on patients before.

Off to the cardiologist Friday. Luckily I have a copy of my EKG. It stinks for that person who cannot get into a cardiologist for two months. I am glad I live in the US, for now.

anon137627Post 17

Avoid caffeine and aspartame like the plague. Eat small amounts of sugar only when balanced with protein and fat, mostly avoiding refined sugars.

When I have an attack, I immediately drink 16 ounces of ice cold water and lie flat and breathe in and out for a couple of minutes, then hold my breath and listen for the sinus rhythm to return. If it doesn't work, breathe in and out for couple more minutes, and hold and listen for the sinus rhythm.

I have had these attacks since I was 28, and I am now 57. Before menopause, hormonal events were reliable triggers.

anon137171Post 16

I'm 59 and have had PAT since I can remember. The first episode I do remember having - my mom took me to the MD and he put his thumbs on my eyes and put his weight on them - stopped the episode "in a heartbeat"... (pun intended) I was very young but still remember it.

Since then, I've found a couple ways to stop PAT. One is to drink a very cold carbonated beverage - like a whole can of 7up. Another is to lie on my back with my knees above my head. Straining and vagal massage have never worked. I've had ECG's and holter. Only abnormality was anterior branch block. I've been told it's completely benign - of course from someone who does not have these episodes.

It usually happens when I exert without "warming up". Exercise and cardio do help.

anon127401Post 15

Has anyone had frequent urination in connection with PAT. I'm also on thyroid after partial thyroid ectomy and thought that could be connected. The TSH and T-4 are normal. Anna (74)

anon122804Post 14

PAT is a side effect of Rheumatic Fever, even it there is no valve damage. I have had them since I was three and I am now 66. I stop the PAT by holding my breath or by pressing on the arteries in my neck just under the jawbone, or if the PAT is resistant I use both measures at once while lying down. These actions kick in the nervous system that slows the heartbeat.

I also take 100 mg of Niacin daily to keep my circulatory system opened up and folic acid to prevent clogs. Niacinimide will not work, so I live with the occasional Niacin flush. My vitamins work much better than Valium or Inderal and are cheaper. I only get a PAT if I am very stressed or very tired.

anon112490Post 13

I have had the PAT since 1990 and I have been in the ER twice since the first event and have been administered adenosine to stop and restart the heart. I sometimes could control the episode with breathing technique but not always. Sometimes it could be stopped by plunging my face up to my ears in ice water. Then there were the times I had to have the adenosine.

I am a perfect candidate for ablation, but I am currently taking toprol and it has been controlling it very well. Just a few palpitations occasionally. I am 56. --Patricia

anon91267Post 12

I have had PAT most of my life. I had a bad attack about thirty three years ago and was on Valium and Inderal and Digoxin for a while but stopped taking them. It still comes and goes, but I have put it down to just being me. If you have had your heart checked and it is OK, then PAT is just a nuisance you have to live with.

To ludwyn: this article is talking about PAT not AF. They are two completely separate things! Sorry. That is why you are confused with the article.

arbiterPost 9

Has anyone ever tried to simply run to catch up with the heart and then slow down the run and bring it down with you? I have never tried it, but I could because I don't get dizzy or light headed or have chest pain. Just a fast heart of about 150 or so.

I like the standing on head idea, if I can stand on my head. Mostly I just try to do the OM's of meditation and I believe the vibration in the chest is helpful at calming perhaps the vagal nerve.

For me alcohol is the trigger. If I have three or four drinks, I will wake at 2 a.m. with a racing heart. Sometimes a

dream will trigger it - running from monsters triggers the PAT. But at least I always wake up and get it under control in fifteen minutes with extra beta blockers and cold water and relaxed meditation and vagal massage and half sit-ups. I do it all.

I had my first PAT event in 1977 and it lasted eight hours, most of it in a military hospital. I have had numerous re-occurrences last from seconds to several minutes. It comes and goes.

I also have sleep apnea and I believe this was a cause of it.

I have been unable to keep weight off unless I work out four or five hours a day and I snore, both of which I did not do prior to the event.

I bring this up because I believe that they may be connected.

anon67490Post 7

I am 46 and have episodes of PAT on a monthly basis around menstruation. They began with my first pregnancy when I was 33. Usually they last for a few minutes.

Two days ago I had an episode which went on for over two hours (214 bpm). Paramedics were unable to stop it and I was given adenosine intravenously in the ER. This drug blocks the hearts electrical pulses in the AV node. Basically my heart was stopped. This action got my heart back into normal bpm.

I now have to wait two months for a cardiologist to see me. I have private health care and live in Australia. I am scared to death, dreading my next menstruation cycle as these PAT episodes occur like clockwork. Does anyone know of a natural remedy I can obtain to see me through to my appointment.

anon67113Post 6

I started having rapid heartbeat, palpitations, dizziness etc., a few years ago and saw various GPS, who decided I was having panic attacks - a.k.a. - suffering from anxiety attacks.

Though I argued that it sometimes woke me up at night (!) when I couldn't be panicking, it's taken me 7 years to get to wear a heart monitor (24 hours). Awaiting the results - feels like trying to catch a mouse, that nobody else can see or believes in! Good luck, all.

anon63402Post 5

I am 26 and have only had four or five occasions of PAT, every time they started after leaning over/down. I am a nurse, working in a doctor's office and was able to track two of my occasions on EKG.

I have also had to have my heart stopped and restarted after one occasion lasted an hour and a half. These remedies that everyone has noticed helping are called "vasovagal" exercises, hold your breath and push down as if having a bowel movement, putting pressure on your heart or lungs in any way. These can help.

Needless to say, PAT is a hard to put your finger on kind of "disease." Good luck to everyone.

anon54237Post 4

After 10 years of symptoms, my PATs were finally caught on an ER rhythm strip one night when they lasted for more than 20 minutes. even though I take metoprolol twice daily, i still have them.

interestingly enough, when i feel them coming on, a good "burp" of gas from my stomach seems to stop the palpitations. I do have GERD treated with PPI (Prevacid), but I still seem to have PATs on occasion. Heidi

anon53936Post 3

I had PAT since the age of 17. As a young adult they were constant -- three to four times a day. It was awful.

I knew how to stop them by holding my head, bending over while sitting down, and arching my back. That would stop the fast rhythmic heartbeat, but it would fire up again almost predictably.

The answer? I went to the ER and then a cardiologist when I was 30. He put me on Cardizem 180mg LA and Inderal and they stopped happening plain and simple. I am now 48 and I have only had one incident in 18 years - I am now 48. Good luck people.

anon49639Post 2

I began having PAT's at age 17. I discovered a few tricks that i could do to stop them after they got really really strong. I would hold my breath and fall back quickly on the sofa with my head hanging off the side of the sofa. With the rush of blood to my head it would stop suddenly with a *thud*.

At about age 45-50 I had one start that would not quit and went to the ER. Fortunately for me my cardiologist was there and he gave me valium and took me into the operating room and stopped my heart completely and then he restarted it. i am now 79.5 years of age and still have them even with taking inderal. Now they are only flutters!

ludwynPost 1

I have suffered with Atrial fib for 33 years years and i have had lots of cardioversions and been ablated and nothing as worked!! lots of different drugs which also do not work so it is very misleading to read this and that puts it right. AF cannot be cured only kept under control...sometimes Christine

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